| NPI | 1467100859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10023447) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OR 201141589RN) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-03-14 |